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ADHD Institute Register

2 Mar 2017

Chou W-J et al. J Behav Addict 2017; 6: 42-50

Adolescents with ADHD have been found to be at higher risk of Internet addiction, which may adversely affect physical and mental health, relationships and academic performance. This study aimed to examine the association between social skills deficits and Internet addiction and activities in adolescents with ADHD. Furthermore, the effects of demographic, parental and ADHD characteristics and comorbidity were also examined in this context.

Patients (aged 11–18 years) diagnosed with ADHD according to the Diagnostic and Statistical Manual of Mental Disorders – 5th edition were recruited from two psychiatric outpatient clinics in Kaohsiung, Taiwan between August 2013 and July 2015. Over the month prior to the study, social skills deficits were measured using the parent-reported Social Skills and Behaviours Checklist for Children and Adolescents (SSBCA-C),* Internet addiction and activities were measured using the Chen Internet Addiction Scale (CIAS) and ADHD characteristics were assessed using the Swanson, Nolan and Pelham Version IV (SNAP-IV) scale – Chinese version. The participants were also questioned regarding the types of Internet activities in which they engaged, e.g. online gaming, online chatting, etc. Parents’ socioeconomic status (SES) and patients’ psychiatric comorbidity were also recorded.

Of the 300 adolescents (mean age 12.8 years; 86.3% male) 42 (14.0%) participants had Internet addiction. Results indicated that, compared with adolescents without Internet addiction, adolescents with Internet addiction had more severe social skills deficits (mean [standard deviation (SD)] SSBCA-C scores: 126.5 [20.8] vs 103.3 [21.6]; p<0.001), inattention symptoms (mean [SD] score: 14.3 [6.0] vs 12.4 [5.8]; p=0.043) and oppositional symptoms (mean [SD] score: 12.0 [6.1] vs 9.5 [5.6]; p=0.009). Furthermore, adolescents with Internet addiction were more likely to have low maternal occupational SES [88.1% vs 65.5%; p=0.003) and were less likely to receive medication for ADHD (73.8% vs 86.4%; p=0.035) than those without. Results also indicated that low maternal occupational SES and social skills deficits (odds ratio [OR] 1.049; 95% confidence interval [CI] 1.030–1.070) were significantly associated with Internet addiction (OR 4.349; 95% CI 1.555–12.165). T-test results indicated that adolescents who engaged in online gaming (p=0.007), bulletin board systems (p=0.033) and watching movies (p=0.026) had significantly more severe social skills deficits than those who did not engage in these activities.

Several limitations were associated with this study: 1) the study had a cross-sectional design, which limited the conclusions that could be drawn regarding causal relationships between social skills deficits and Internet addiction; 2) how the associations developed was not examined; 3) participants were recruited from clinical units only; 4) the moderating effects of other factors known to have negative impacts on outcomes in adolescents with ADHD, e.g. conduct disorder, were not examined.

Results from this study found that adolescents with ADHD and Internet addiction had more severe social skills deficits than those without Internet addiction. Social skills deficits were significantly associated with Internet gaming and watching movies, and maternal occupational SES moderated the association between social skills deficits and Internet addiction.

Read more about ADHD and risk of Internet addiction here


*The 43-item SSBCA-C assessed the participants’ social skills in the dimensions of self-performance, interpersonal relationships and occupational behaviours. Each item for the social skills of adolescents was rated by parents using a 5-point Likert scale from 1 (never) to 5 (always), with a high total score indicating severe deficits in social skills
Self-reported internet addiction severity levels were assessed using the 26-item CIAS scale; a 4-point Likert scale with scaled score ranging from 26 to 104. A high total score indicated severe Internet addiction
The 26-item SNAP-IV -Chinese version rating instrument included core ADHD subscales (inattention and hyperactivity/impulsivity and oppositional symptoms of oppositional defiant disorder). The 26 items were rated on a 4-point Likert scale from 0 (not at all) to 3 (very much), with high total scores indicating severe ADHD and oppositional symptoms

Chou W-J, Huang M-F, Chang Y-P, et al. Social skills deficits and their association with Internet addiction and activities in adolescents with attention-deficit/hyperactivity disorder. J Behav Addict 2017; 6: 42-50.

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